MMI Network News, February 2013

While reading the outcome statement and background document of
the joint World Bank/WHO ministerial level meeting on Universal Health coverage
held last week, two clear issues emerge: The first one is getting political
commitment to UHC at the highest government level; the second one is that
“fiscal realities (in poor countries in particular) greatly constrain the
ability to rely predominantly on public funding. Still, countries do not need
to be rich to make progress towards UHC, experience suggest that political
commitment is essential.”

The papers seem to suggest that fiscal
reality is cast in stone and that within this fiscal reality countries have the
political space to move forward to UHC. This approach, in essence, tells us
something about the sad situation we have come to live in. A reality in which
the financial oligarchy have taken over country democracies, according to Simon Johnson’s The Quiet Coup.
A reality in which economic inequalities have
an enormous negative impact on health equity and social wellbeing. Untaxed private wealth
hinders many countries to finance strong public systems to reach or maintain
Universal Health Coverage.

It is not only a problem of poorer countries.
We have the same within the European Union. For instance 23.400 “mailbox”
companies are registered in the Netherlands, with its infamous tax heaven
industry. It lead for instance to Portuguese and Spanish multinationals to
avoid paying tax in their respective countries. Both Spain and Portugal have to
severely cut their public spending on health
expenditures and privatize part of their health services, as
required by austerity measures set by the European Union. Even the G20 starts to recognize
that the tax avoidance by big business is a big problem for the social
development of societies.

These examples merely indicate that the issue
of fiscal space and progress on UHC are closely interlinked. The Lancet Article
“Political and economic aspects of
the transition to universal health coverage” explains it as follows:
“UHC will only be achieved if public policies ensure that a large share of this
increased spending is pooled through a mechanism that promotes equitable and
efficient utilization of care. The exact mechanisms for pooling will depend on
social processes and political action that establish the parameters for an
acceptable public role in health care. In some cases, the result will be a
government that primarily regulates the health-care sector, in other cases a
government that finances or directly provides care.” In many emerging
economies, such as South-Africa, Indonesia; but also in European countries with
traditional generous social security systems, there is strong political
pressure to remain attractive for international (financial) investors. In
parallel there is similar pressure to reduce public spending on health care and
create space for health insurance companies in the market of (mandatory) social
insurance packages. Authors have coined this process of tax competition “a race to the bottom in slow motion”,
with specific policies becoming less generous without disappearing, or creating
a public debt that will eventually force their termination.

The authors also suggest a mechanism to mitigate this race to the
bottom, the so called social protection floor. The idea
underpinning this initiative is that all states would commit to agreed minimum
levels of social protection tailored for their respective country. The UN General Assembly resolution
concerning universal health coverage acknowledges
the link between universal health coverage and social protection mechanism,
and urges member states to give priority to these links within their national
social programs and policies.

The
contradiction is obvious: There is a strong drive to have Universal Health
Coverage included in the post 2015 development agenda and for countries to
advance UHC at national level. At the same time these countries are dealing
with (global) tax competition, tax evasion and a deregulated financial sector
that is playing with casino capital at a global level. It is a good first step
that WHO and World Bank work with member states to increase capacity and
undertake steps towards universal health coverage. Actors working on advancing
UHC inevitably will come to the issue of claiming national policy and fiscal
space as a basic macro-economic condition for a country to advance its coverage
of social protection and health services. Good examples in these include Brazil
and Thailand.

The
question is whether all the countries that are now supporting the cause of UHC
are willing to make progress on further regulation of the financial sector and
reform of their fiscal policies. Are these countries able to agree on global
redistribution mechanisms and regulatory mechanism to curb the massive amount
of untaxed wealth and casino capital, and hence free considerable resources to
fund the national social protection floors? Will countries be able to develop
true “progressive” taxation schemes, not merely income or VAT based, but rather
on wealth and CO2 emission? Or do we want rather global philanthropy to
provide the complimentary funds for advances in UHC and social security?

Bottom
line: Universal Health coverage is in essence linked to political demands,
choices and inherent power relations, both at the national and global level. If
we all agree to have UHC included in the post 2015 agenda, then we should be
willing to be truly involved in the political and ideological battle that will
enfold over the coming period.

“Most women in Africa do not know about their cycle and the fertile window. As
a result one quarter of all pregnancies are unwanted. In our practical training
for mostly illiterate women in The Gambia we use a simplified "Modified
Mucus Method". Research should show whether the training helps women to
control their fertility.”

This is the very first NGO research
proposal put on the newly established MMI marketplace “NGOs in search of
research: our request – and our offer". We invite other Network members
and partners to do the same. NGO proposals are not binding, but shall allow the
start of a dialogue. The Medicus Mundi International Network will provide and
promote this marketplace, but will leave it up to the interested parties (NGO,
researcher, training institution) to lead this dialogue, to eventually agree on
terms of cooperation and to establish an appropriate contractual relation.

This year again medico international will be
part of the German Public Health Congress Poverty and Health. We invited
partners and other well know speakers (MMI secretary Thomas Schwarz will
provide an input on "Health Workers – Human capital for the global
market?") to discuss with us the ill-effects of the current global trade
regime and financial market.

At this event related to the World TB Day (24 March), Doctors with Africa Cuamm presents its strategy for the organization's involvement in the fight against TB in the next three years - in Italian only.

.............
Network event: Medicus Mundi SwitzerlandPrimary Health Care and NCDs in Eastern
Europe and Central Asia: Where do we stand and where to go?Basel, 10
April 2013

Over the past two decades health systems in Eastern Europe and Central Asia
have undergone substantial changes in relation to their financing and the way
how services are delivered to the population. In many countries a shift from
hospital centred to primary health care focused systems have taken place: the
number of hospital beds and hospitals were reduced in an important way and
family doctors sometimes embedded in family medicine teams are today the first
point of contact to deliver essential services to the population. At the same
time Non-Communicable Diseases (NCDs), such as cardio-vascular disease or
diabetes, have become more predominant and are today responsible for a
significant share of the burden of disease in these countries. The symposium
will allow participants to learn from recent experiences in countries of
Eastern Europe and Central Asia in strengthening primary health care services
and their relation to NCD prevention and treatment. (Symposium of the Swiss
TPH, a member of the Network Medicus Mundi Switzerland.)

A future without AIDS is possible. However, it takes concerted efforts by all
to make this vision come true. aidsfocus.ch will together with stakeholders
from South and North assess and reflect on what we reached so far and identify
and discuss promising and successful initiatives and strategies to face
challenges for the future of the AIDS response. A special focus will be on role
and priorities of aidsfocus.ch in the joint struggle toward a future without
AIDS. (aidsfocus.ch is a project coordinated by Medicus Mundi Switzerland)

"Thailand and Brazil, countries with deeply
different traditions and cultures, have both opted to invest in primary care to
guarantee all citizens the right to care. A lesson for all of us, 34 years
after the Alma Ata Declaration. Despite of this, in Europe universalistic
health systems are likely to be swept away by the neo-liberal policies."

Gavino
Maciocco in: Health and Development No. 65, "Bridging the gap",
December 2012. Health and Development is the quarterly journal of Doctors with
Africa Cuamm. Download the journal in order to read the full article.

“Charity once was a
driving force of what became social protection. It no longer is. Social
protection is not about charity. When we pay our taxes or social insurance
fees, we are not donors of aid, we are paying our dues; when we receive support
in the form of subsidised health care or teachers for our children whose salaries have been paid, we are not recipients of aid. We
pay our dues and we use our entitlements, and we consider it a collective
effort to build a fair and equitable society. That is solidarity, not charity.

Can we imagine a
funding mechanism for Global Social Protection between people living in
different countries, relying on each other and supporting each other,
contributing to a fair and equitable global society? – medico international and
the Hélène de Beir Foundation can. We think that most people can adhere to the
principles of Global Social Protection. We do not aim for a global social
protection scheme that replaces national social protection schemes; we think
that national social protection schemes will benefit from a global scheme. We
think we can learn from social protection equalisation schemes, like they exist
within and among many high-income countries (Australia, Belgium, Canada,
Germany, and others). The objective of a three days expert workshop on
Financing Global Social Protection was to challenge the metaphorical devil in
the detail. We know we must move from global charity to global solidarity.”
(Workshop Reader edited by Jens Holst on behalf of medico international and Hélène-de-Beir
Foundation)

The Swiss Malaria Group (with Medicus Mundi Switzerland as a member)
hosts an online photo contest: "Malaria affects the lives of millions
across the world. The Swiss Malaria Group* online photo contest seeks to
highlight the realities of those living at risk of malaria and the work of
those dedicated to changing that reality. The contest is open to all. Send in
your photos and captions that tell a story about malaria between 15 February
and 24 March via the competition website, where you will find details of the
three submission categories. The public will then vote to determine the
finalists and a panel of expert judges will select the winners. Have you got a
photo that can tell a story about malaria? Then send it in!"

A humanitarian campaign in Burkina Faso promoted by Medicus Mundi Italy
and Spedali Civili Hospital (Brescia, Italy): Make sure a weaning child in
Burkina Faso receives enriched flours for 4 months. Because he or she needs to
grow just like our children.

Bits and pieces of news on international
health policy: each “MMI update” is 140 characters or less - these are the
rules of the game on twitter. Just enough for a headline, eventually an author,
a date, the source – and a link to the website where you find the full
information. Have a look at some of our “tweets” published during the last
month. As usual, it’s a bit much, so take it or leave it. And, as usual, you
will see how difficult it is to put a resource under the “right” heading.